Q: Dear Bone Doctor; What kind of cast do most surgeons use for a scaphoid fracture? If I ask for a long arm cast instead of a short would they apply one? Gary C.

A: Dear Gary; The treatment for a scaphoid fracture is based on many factors including the type of scaphoid fracture, the displacement of the fracture and the age of the patient. Most scaphoid fractures tend to occur in younger patients usually after a fall on an outstretched hand.

Historically, if the fracture was non-displaced, that is the bone was broken but there was no movement in the fragments, a long arm cast was used. However, recent research has now suggested that even for these non-displaced fractures especially in younger patients, a surgical treatment might be necessary.

The reason for treating these fractures with surgery is that the blood supply to the scaphoid is very fragile and even the slightest amount of displacement can damage the blood supply leading to a non-union. Therefore perfect to almost perfect reduction is necessary to avoid damage to the blood supply.

If the blood supply is indeed damaged and the reduction of the fracture is not perfect or near perfect, the scaphoid fracture might not heal and lead to a non-union or avascular necrosis (AVN).

In AVN the bone does not heal but rather dies since there is no blood supply. Surgery is also strongly recommended for those patients with a displaced scaphoid fracture.

In those fractures in which there is no displacement, a long arm cast is preferable to a short arm cast since a long arm cast offers better immobilization and will offer a better chance for the fracture to heal.

As to whether or not your doctor will apply a long arm cast, a lot depends on what the radiographs look like and whether the fracture is displaced or not.

If a long arm cast is applied, it can take up to 12 weeks before the fracture heals. During that time radiographs are taken at regular intervals to see if the fracture is healing. If there is no evidence of healing then a decision can be made as to whether surgery is necessary.

Regardless of whether the fracture is treated by casting or surgery, physical therapy is often prescribed to help regain wrist motion.

The opinions expressed are solely those of the writer. Dr. Dwight Tyndall is a practicing Spine Surgeon. He can be reached at dstyndall@yahoo.com (use the subject line "bone doctor column"), www.spinecarespecialists.com or at Dr. Dwight Tyndall, 730 45th St., Munster, IN 46321. This column is intended for informational purposes only. Readers should seek specific medical advice from their own physician.